Optimum Care (South) Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were protected from the risk of harm and abuse. There were sufficient staff in place to support people. People were supported by familiar staff who understood their needs. However, we found three breaches of the legal regulations in relation to safeguarding, safe care and treatment and notification of incidents to CQC. Risk Assessments were not sufficiently detailed and contained contradictory information. Medicines were not always safely managed and competency checks had not been completed for all staff who administered medicines. Not all staff had received safeguarding training and assessments of mental capacity had not always been completed in line with the principles of the Mental Capacity Act 2005. We raised these issues with the provider and some risk assessments were updated during the course of our assessment, to ensure any immediate risk to people was mitigated. The provider had plans in place to review all care plans and risk assessments and update staff medicine competency checks and this work was ongoing.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe with staff and were confident and happy to raise any concerns they had with the management team. One person told us, “They are good. They are concerned. They always ask me how I am. Do I need anything. They are considerate and lovely.”

Staff understood their responsibilities to keep people safe. They understood about safeguarding procedures and whistleblowing. Staff felt that the people they supported were safe with the support they received. One staff member told us, “'I will report every day if I need to, I can’t ignore things if my client is not happy or if there is something wrong'.

There were procedures for safeguarding people. When there had been allegations of abuse, the provider had worked with the local authority to investigate these. However, systems and processes did not support the ongoing monitoring of safeguarding concerns. The nominated individual confirmed that, in the absence of the registered manager, they had been unable to locate all documentation in relation to safeguarding concerns that had been raised. This meant the provider’s oversight of incidents at the location was limited. Furthermore, not all staff had completed safeguarding training. The service has a legal requirement to notify the Care Quality Commission of certain notifiable incidents or events. We found that not all notifiable events had been reported. The nominated individual was open and honest in accepting that this was likely to have been an oversight by the registered manager. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Mental Capacity Assessments formed part of people’s care plans. However, these were not decision nor time specific, in line with the principles of the MCA.

People and their relatives were positive about the care received and how risks were managed by staff. One person told us, “Staff include me in what I want and what I need.” People told us that staff knew them well and provided safe care. One person told us, “I get on with them…they know me, and they know my history. They know my difficulties.”

Staff we spoke to were aware of the potential risks that could impact on the support provided. Most staff we spoke with told us they had access to risk assessments and could seek management support if they required any additional advice. However, some staff reported risk assessments as missing or lacking the specific details required to enable them to effectively support people.

Risk assessments did not provide staff with the information they needed to ensure people’s care was provided safely. In some instances, risks were identified but not responded to with appropriate management plans and monitoring. In other examples, care plans and risk assessments contained conflicting or unclear guidance for staff. People with specific health conditions such as epilepsy, dysphagia, diabetes and/or pressure wounds did not have adequately detailed care plans in place. Risk assessments were not completed for people using bed rails and personal fire evacuation plans were not personalised to individual support needs. This meant people were at risk of receiving unsafe care. The provider told us they were in the process of reviewing all care plans and risk assessments. However, during the assessment we asked the provider to carry out a review to ensure any immediate risks to people’s safety were mitigated. Risk assessments and associated management plans were updated during the course of the assessment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us there were enough staff to meet people’s needs. They told us they were usually supported by a small, regular group of staff who understood their needs. One person told us that they had specified a need for familiar staff and “they (the provider) understood that, and they’ve been great with it.” There were some incidents of lateness and occasional missed care calls, but people did not express any concerns in relation to this. People told us they were fully kept informed and understood that sometimes changes were unavoidable. People and their relatives told us they felt staff were well trained and had the right skills and experience. One relative told us, “They do know their job. They look after [relative] very well.”

Staff told us that staffing levels were appropriate. They told us they worked well as a team to ensure all shifts were covered and to enable people to be supported by familiar staff. Staff did not always receive regular supervision, however, they confirmed they were comfortable raising concerns and seeking support when they required it. One member of staff told us, “I’ve never had to struggle in terms of escalating any issue.”

Processes were in place to ensure all care calls were covered on the rota. A remote monitoring system allowed for calls to be monitored in “real time” and the management team explained that any “persistent lateness” was followed up. There were some gaps in staff training and not all staff had completed the care certificate. There were also gaps in induction, supervision, spot check and competency records. The provider was aware of these gaps and was in the early stages of implementing new systems and processes to address these issues. Staff were recruited safely, and recruitment records reflected this. Procedures were in place to ensure the required checks were carried out on staff before they commenced their employment. This included enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they received their medicines as prescribed. One person told us, “I get a blister pack. They take the medication out of the blister pack and they put it in the little pots for me.”

Staff told us they had received medication training; however, they were unsure regarding the frequency of competency checks. Staff were able to explain how they safely administer medicines, including what action they would take in the event of a person refusing their medicines. Some staff were not clear about the provider’s policy in relation to “as required” medicines and if they were able to administer over the counter medicines.

Protocols were not in place for all PRN “as required” medicines, including for controlled drugs, such as morphine. This meant there was no guidance for staff to ensure medicines were being given in line with the prescriber’s instructions. This put people at risk of receiving unsafe care. There were also gaps in medication care plans. This included a lack of information regarding medicines deemed “time sensitive”, unclear instruction for staff in relation to pain relief patches and limited guidance for staff supporting people with a diagnosis of epilepsy. Medicine administration competency assessments had not been completed for all members of staff. This had been identified by the provider and was being addressed at the time of this assessment. In addition, some staff were administering suppositories, without having received training from a healthcare professional, as outlined in the provider’s medication policy. We highlighted these issues to the provider during the assessment who sought to ensure any immediate risks were mitigated.